Provider Demographics
NPI:1013129998
Name:JEFFERSON COUNTY HOMEMAKER-HOME HEALTH AIDE SERVICE
Entity Type:Organization
Organization Name:JEFFERSON COUNTY HOMEMAKER-HOME HEALTH AIDE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCKEEVER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:641-472-5929
Mailing Address - Street 1:200 W BRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2826
Mailing Address - Country:US
Mailing Address - Phone:641-472-5929
Mailing Address - Fax:641-469-3189
Practice Address - Street 1:200 W BRIGGS AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2826
Practice Address - Country:US
Practice Address - Phone:641-472-5929
Practice Address - Fax:641-469-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0149492Medicaid